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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 397004738
Report Date: 07/28/2022
Date Signed: 08/10/2022 09:07:41 AM

Document Has Been Signed on 08/10/2022 09:07 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:CAMELLO HOME 1FACILITY NUMBER:
397004738
ADMINISTRATOR:CAMELLO, KIMBERLYFACILITY TYPE:
735
ADDRESS:2203 MICHIGAN AVENUETELEPHONE:
(209) 598-2036
CITY:STOCKTONSTATE: CAZIP CODE:
95204
CAPACITY: 5CENSUS: DATE:
07/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Lizbeth Castillo, Co-AdminTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) R. Campbell conducted an unannounced Annual 1-Year Required visit on this date. LPA met and toured with Administrator Lizbeth Castillo. The administrator currently holds a certificate (#6054394735) that expires on 06/21/2023. The facility’s fire clearance was approved on 06/05/2011.

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. There are no bodies of water observed. A comfortable temperature is maintained at 74 degrees Fahrenheit. The hot water temperature is maintained at 111 degrees Fahrenheit. All outdoor and indoor passageways were kept free from obstruction. Rooms were furnished appropriately. There was an adequate supply of toiletries, hygiene supplies, and extra linens. LPA observed clients’ linens were in good repair. There is a minimum of 7-day nonperishables and 2-days worth of perishable foods.

The last disaster/fire drill was last conducted on 07/15/2022. Fire extinguishers, smoke detectors and carbon monoxide were checked. LPA reviewed staff record files and the facility has sufficient staffing to provide the services needed to serve their residents.


Exit interview conducted. Appeal Rights and a copy of this report provided.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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